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Ann Thorac Surg 2003;75:1697-1704
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

A modified bronchial anastomosis technique for lung transplantation

^a Department of Cardiac and Thoracic Surgery, Vanderbilt University, Nashville, Tennessee, USA
^b Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA

Accepted for publication December 22, 2002.

^* Address reprint requests to Dr Pierson, Division of Cardiac Surgery, University of Maryland, 22 South Greene St N4W94, Baltimore, MD21201, USA.
e-mail: rpierson{at}smail.umaryland.edu

BACKGROUND: Low rates of major complications have been reported for the intussuscepting bronchial anastomotic technique but stenosis, malacia, and granulation tissue at the anastomosis may cause clinically important morbidity. We hypothesized that a modification of the telescoping technique that improves bronchial wall apposition might be associated with improved bronchial healing and clinical outcomes.

METHODS: The telescoping horizontal mattress "U-stitch" suture technique was modified to incorporate figure-of-eight sutures placed in the cartilaginous wall between each of three intussuscepting U stitches. Serial videotape records of 152 individual anastomoses (99 modified, 53 telescoped) in 118 consecutive operative survivors were retrospectively reviewed by examiners blinded with respect to technique used. Stenosis, airway instability, mucosa quality, and devascularized luminal tissue were graded at 4 to 14 days (initial), 4 to 12 weeks (early), and 6 to 12 months (late) after transplantation.

RESULTS: The incidence of anastomotic stenosis was significantly lower using the modified technique at the initial (p = 0.025) and late (p = 0.015) observations. In the initial phase airway instability (p = 0.015) and devascularization grades (p = 0.001) were also significant lower in the modified group. There were no significant differences in mucosal condition between techniques. The modified telescoping technique was associated with significant survival advantage (mean 17.7%; p = 0.029) by multivariate analysis. The incidence of major airway complications (dehiscences and stenoses required stents) tended to be lower (3% versus 6%) in the modified group.

CONCLUSIONS: The modified telescoping bronchial anastomosis technique is associated with improved early and late bronchial healing and higher 5-year survival without increased major airway complications.

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